Effects of maternal epidural analgesia on the neonate - a prospective cohort study
|
|
- Colin Hoover
- 5 years ago
- Views:
Transcription
1 Shrestha et al. Italian Journal of Pediatrics (2014) 40:99 DOI /s x ITALIAN JOURNAL OF PEDIATRICS RESEARCH Open Access Effects of maternal epidural analgesia on the neonate - a prospective cohort study Bikash Shrestha 1*, Amit Devgan 2 and Mukti Sharma 2 Abstract Background: Epidural analgesia is one of the most popular modes of analgesia for child birth. There are controversies regarding adverse effects and safety of epidural analgesia. This study was conducted to study the immediate effects of the maternal epidural analgesia on the neonate during early neonatal phase. Methods: A prospective cohort study of 100 neonates born to mothers administered epidural analgesia were compared with 100 neonates born to mothers not administered epidural analgesia in terms of passage of urine, initiation of breast feeding, birth asphyxia and incidence of instrumentation. Results: There was significant difference among the two groups in the passage of urine (P value 0.002) and incidence of instrumentation (P value 0.010) but there was no significant difference in regards to initiation of breast feeding and birth asphyxia. Conclusions: Epidural analgesia does not have any effect on the newborns in regards to breast feeding and birth asphyxia but did have effects like delayed passage of urine and increased incidence of instrumentation. Keywords: Birth asphyxia, Breast feeding, Epidural analgesia, Neonate, Newborns Background Safe neonatal outcome is the ultimate aim of any delivery. Pain management is a major issue and part of normal labours. Among various modes of pain management, epidural analgesia is considered a very safe and popular mode of analgesia for child birth [1-3]. Considering use of various types of analgesia, it would be desirable to know the adverse effects of any analgesia being used. Epidural analgesia is one of the extensively studied modes of analgesia in labours. Most studies which have been conducted over epidural analgesia primarily focus on the maternal parameters [3-6]. Despite its popularity, epidural analgesia has remained controversial in regards to its safety [4-6]. The meta-analysis regarding the safety of epidural analgesia has remained inconclusive [7,8]. Considering the controversial aspects of epidural analgesia, we intended to study the immediate effects of epidural analgesia in the newborns born to mothers with epidural analgesia and compare with the newborns born to mothers without epidural analgesia. * Correspondence: kalmaan@yahoo.com 1 Department of Pediatrics, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Swayambhu, Chhauni, Kathmandu 44620, Nepal Full list of author information is available at the end of the article Methods and methodology Methods 100 consecutive mothers who were given epidural analgesia and 100 mothers who were not given epidural analgesia for normal labours were enrolled into the study. The neonates born to two groups of mothers were compared in regards to the time of passage of urine, the initiation of onset of breast feeding, birth asphyxia and instrumentation in the form of vacuum or forceps delivery. Inclusion and exclusion criteria The mothers who were regularly followed up in our antenatal clinic were included in the study after taking the informed consent. Caesarean sections, preterms (Less than 37 weeks of completed gestation), low birth weights (Less than 2.5 kg), antenatally detected major congenital anomalies, multiple gestations, high risk antenatal factors like gestational diabetes, pregnancy induced hypertension, recurrent abortions, elderly primigravida (Above 40 years) and those who did not provide consent were excluded from the study Shrestha et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
2 Shrestha et al. Italian Journal of Pediatrics (2014) 40:99 Page 2 of 5 Study design, sample size and place of study Incidence of epidural analgesia is around 3-5% of all labours in our institute. Considering the delivery rate of around 3000 per year, 100 cases each of epidural analgesia and 100 controls without epidural analgesia was determined sample size. The prospective cohort study was conducted in a tertiary care teaching hospital in India between Jan 2012 and Jan The study was approved by the institutional review board committee of Maharashtra University of Health Sciences, Nashik, India. Methodology Epidural analgesia is given voluntarily to the normal delivery cases in our institute. Informed written consent was taken from the participants. The pregnant ladies who demanded analgesia for labour pain were provided with epidural analgesia, consisting of 10 ml of 0.125% bupivacaine & 20 mcg fentanyl. The neonates born were followed up to 3 days to note the various study parameters including passage of urine, onset of breast feeding, birth asphyxia and instrumental interventions if any. The study performa were filled up by the duty resident every day during the morning and evening rounds. During the same period, neonates who were born to mothers without epidural analgesia were also followed up and various parameters noted. The results were compared among the two groups and statistical analysis was done using the software Epi Info and P value was calculated by Chi square test and Fisher s exact test. P value of <0.05 was considered as statistically significant. Results Table 1 represents the comparative baseline maternal demographic data of the two groups in regards to parity, Table 1 Baseline maternal demographic data compared between the epidural and non epidural groups Cases Control P value Parity Primi Multi Age group < 20 years years > 30 years 2 4 Address Within same district Out of same district 18 9 Religion Hindu Muslim Christian 1 3 age group, the addresses and the religions. The baseline maternal data between the two groups are non significant. Table 2 represents the sexes and the different weight groups of newborns in the two groups which were comparable to each other. The timing of passage of urine by the newborns that were born with and without epidural analgesia has been represented in Table 3. The passage of urine in first six hours, then between six and 24 hours and more than 24 hours were noted. 42 newborns in epidural analgesia group and 58 newborns in non epidural analgesia group had passed urine in the first 6 hours. In the six-24 hours group, there were 49 newborns in epidural group and 42 in non epidural group. There were total 9 newborns that passed urine beyond 24 hours and all of them were in epidural analgesia group. The P value was highly significant among the two groups (P value-0.002). Thus, the results have shown that in newborns born to mothers with epidural analgesia, there is higher tendency to pass urine later than the newborns without epidural analgesia. The timing of initiation of breast feeding among the newborns those were born to mothers with and without epidural analgesia is shown in Table 4. The timing of breast feeding was divided into 3 groups, 0-six hours, six-24 hours and more than 24 hours. In epidural group and non epidural group, there were 96 and 98 newborns each who had established breast feeding successfully within six hours. Only one newborn in both the groups had established breast feeding between six-24 hours. In epidural group, there were three cases and in non epidural analgesia, there was only one case where breast feeding was established after 24 hours. The P value among the two groups was not significant (P value 0.60). The number of birth asphyxia which has occurred are tabulated in Table 5. In epidural analgesia group, three had birth asphyxia and in non epidural analgesia, only one had birth asphyxia. Although higher number of birth asphyxias had occurred in epidural group, it was not statistically significant (P value 0.621). The number of instrumental deliveries which had taken place in the two groups has been depicted in Table 6. Of Table 2 The sex and weight groups of the newborns in the epidural and non epidural groups Cases Control P value Sex Male Female Birth weight group kg kg kg 3 3
3 Shrestha et al. Italian Journal of Pediatrics (2014) 40:99 Page 3 of 5 Table 3 The timing of passage of urine in the epidural and non epidural groups Time of passage of urine Cases Control Total P value 0-6 hours hours >24 hours the total 13 instrumental deliveries, which included both vacuum and forceps, 11 were from epidural analgesia group and only two were from non epidural analgesia group. The result in the two groups was highly significant (P value 0.010). Discussion We had studied the various parameters in the newborns born to epidural analgesia group and compared with the newborns born to mothers without epidural analgesia. The results included the timing of passage of first urine, onset of breast feeding, birth asphyxia and instrumental delivery. The timing of passage of urine had been divided into 3 groups, a) within first six hours, b) between six & 24 hours and c) more than 24 hours. In the study, lesser numbers of newborns had passed urine within the first six hours in epidural analgesia group (42 out of 110 or 38.2%) than non epidural analgesia group (58 out of 110 or 52.8%), whereas higher number of neonates had passed urine after six hours in the epidural analgesia group (49 out of 91 or 53.8%) than in non epidural group (42 out of 91 or 46.2%). Among nine newborns who had passed urine after 24 hours only, all were in epidural analgesia group. Although the passage of urine has been delayed, it was within physiological period of 48 hours. The delay in passage of urine was highly significant among the newborns in epidural analgesia group (P value 0.002). Epidural analgesia is known to cause urinary retention in the mothers post partum due to the effects of fentanyl [3,6,7,9,10]. Most studies are unable to explain the exact mechanism of post partum urinary retention in the mothers with epidural analgesia. There has been no documentation in the literature regarding the urinary retention in newborns born to mothers with epidural analgesia. This study is the first one to report this finding. Probably, the maternal Table 4 The timing of initiation of breast feeding in the epidural and non epidural groups Time of onset of breast feeding Cases Control Total P value 0-6 hours hours >24 hours Table 5 The number of birth asphyxias in the epidural and non epidural groups Birth asphyxia Cases Control Total P value Yes No drug transferred to the newborn could have led to urinary retention as we had used fentanyl in the mothers for epidural analgesia. However, urinary parameters in the mother were not noted in our study. Difficulty in establishment of breast feeding is another controversial issue in the field of epidural analgesia. Successful breast feeding is one of the aims of successful labours. In our study, majority of the mothers had initiated and established breast feeding within six hours of birth confidently (194 out of 200 or 97%). Only six babies had delayed onset of breastfeeding, because of the birth asphyxia and other medical conditions for which oral feeds were withheld. There was no significant difference among the cases and the control groups with P value being Various studies have reported that epidural analgesia may lead to difficulty in establishing early breast feeding [11,12]. There are other studies which refute such relationship [1,13-15]. Epidural analgesia per se should not have bearing upon the initiation of breast feeding in the newborns, unless the overdosing of the analgesia may make the mother feel drowsy and lead to delay in the establishment of breast feeding. Considering the appropriate dose of epidural analgesia, there should be no effect upon the initiation of the breast feeding as elicited in the study. Epidural analgesia has also been implicated in being associated with prolonged labour, respiratory distress and lower APGAR scores in the neonates [16-19]. At the same time, there are other studies which do not support such association [1-3,20,21]. In our study, we had studied the incidence of birth asphyxia in the epidural and non epidural groups. We had considered APGAR less than six at five minutes as birth asphyxia. In epidural analgesia group, three babies had birth asphyxia and in non epidural group, only one baby had suffered birth asphyxia. However, the difference was not statistically significant (P value 0.621). Epidural analgesia may be implicated in prolonging the labors by reducing the pain and thus reducing bearing Table 6 The number of instrumental deliveries in the epidural and non epidural groups Instrumentation Cases Control Total P value Yes No
4 Shrestha et al. Italian Journal of Pediatrics (2014) 40:99 Page 4 of 5 down efforts, however, it is not directly contributing to birth asphyxia per se. Another controversial aspect of epidural analgesia which we intended to study was the higher number of instrumental deliveries associated with epidural analgesia. There are studies which claim higher incidence of instrumental deliveries, including Caesarean delivery with epidural analgesia [19-23]. There are other studies which do not show such relationship [1,2,24]. In our study, Caesarean section was excluded and we could not comment upon the incidence of Caesarean section. In our study total 13 cases required instrumental interventions, including both forceps and vacuum. Out of these, 11 were from epidural analgesia group and only two from non epidural group. The difference in the two groups in the study has been statistically significant (P value 0.010). This may perhaps be explained by the poorer bearing down efforts in the mothers with epidural analgesia. At the same time, it should also be acknowledged that more complicated pregnancies are more likely to be assisted with analgesia and thus may end up being intervened more with instrumental deliveries. Confounding factors like prolonged second stage, dystocias, delayed pushing, more complicated pregnancies, parity, age, may perhaps explain the difference. Summary and conclusions A prospective cohort study was conducted to study the effects of maternal epidural analgesia on the neonate during early neonatal phase. 100 newborns born to mothers who were administered epidural analgesia and 100 newborns born to mothers who were not given epidural analgesia were compared among various study parameters. The newborns born to mothers with epidural analgesia tended to pass urine later significantly than the non epidural group. There was significantly increased incidence of instrumental deliveries in epidural group than in non epidural group. However, there have been no immediate effects upon breast feeding and birth asphyxia in our study. The effect of epidural analgesia on the neonate is of immense significance and should be further explored in the future with more elaborate randomized controlled multi-centre studies. Competing interests The authors declare that they have no competing interests. There is no financial disclosure to be made. Authors contributions BS conducted the study and drafted the manuscript. AD supervised the study and the manuscript. MS edited the entire manuscript and supervised the literature. All authors read and approved the final manuscript. Acknowledgements The authors would like to show their gratitude to all the parents for providing the consent and participating in the study. Declaration This study is a part of the thesis submitted for the Master s Degree in Pediatrics in Maharashtra University of Health Sciences, Nashik, India. Author details 1 Department of Pediatrics, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Swayambhu, Chhauni, Kathmandu 44620, Nepal. 2 Department of Pediatrics, Armed Forces Medical College, Pune , India. Received: 13 August 2014 Accepted: 22 November 2014 References 1. Gizzo S, Di Gangi S, Saccardi C, Patrelli TS, Paccagnella G, Sansone L, Barbara F, D Antona D, Nardelli GB: Epidural analgesia during labor: impact on delivery outcome, neonatal well-being, and early breastfeeding. Breastfeed Med 2012, 7: Reynolds F: Labour analgesia and the baby: good news is no news. Int J Obstet Anesth 2011, 20(1): Anim-Somuah M, Smyth RM, Jones L: Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev 2011, 12:CD Lieberman E, O Donoghue C: Unintended effects of epidural analgesia during labour. Am J Obstet Gynecol 2002, 186:S31 S Eberle RL, Norris MC: Labour analgesia. A risk-benefit analysis. Drug Saf 1996, 14: Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP: Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev 2012, 3:CD Cambic CR, Wong CA: Labor analgesia and obstetric outcome. Br J Anaesth 2010, 105:i50 i Halpern SH, Muir H, Breen TW, Campbell DC, Barrett J, Liston R, Blanchard JW: A multicentre randomized controlled trial comparing patient controlled epidural with intravenous analgesia for pain relief in labour. Anesth Analg 2004, 99: Musselwhite KL, Faris P, Moore K, Berci D, King KM: Use of epidural anesthesia and the risk of acute postpartum urinary retention. Am J Obstet Gynecol 2007, 196:472.e1 472.e Liang CC, Wong SY, Tsay PT, Chang SD, Tseng LH, Wang MF, Soong YK: The effect of epidural analgesia on postpartum urinary retention in women who deliver vaginally. Int J Obstet Anesth 2002, 11: Beilin Y, Boodian CA, Weiser J, Hossain S, Arnold I, Feierman DE, Martin G, Holzman I: Effect of labor epidural analgesia with and without fentanyl on infant breast feeding. Anesthesiology 2005, 103: Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA: Intrapartum epidural analgesia and breast feeding: a prospective cohort study. Int Breastfeed J 2006, 1: Radzyminhski S: The effect of ultra low dose epidural analgesia on newborn breastfeeding behavior. J Obstet Gynecol Neonatal Nurs 2003, 32: Wiklund I, Norman M, Uvnas-Moberg K, Ransjo-Arvidson AB, Andolf E: Epidural analgesia: breastfeeding success and related factors. Midwifery 2007, 25:e31 e Wilson MJ, MacArthur C, Copper GM, Bick D, Moore PA, Shennan A, COMET study group UK: Epidural analgesia & breast feeding: a randomized controlled trial of epidural techniques with & without fentanyl and a non-epidural comparison group. Anesthesia 2010, 65: Gerli S, Favilli A, Acanfora MM, Bini V, Girogini C, Di Renzo GC: Effect of epidural analgesia on labor and delivery: a retrospective study. J Maternal Fetal Neonatal Med 2011, 24: Decca L, Daldoss C, Fratelli N, Lojacono A, Slompo M, Stegher C, Valcamonico A, Frusca T: Labor course and delivery in epidural analgesia: a case control study. J Matern Fetal Neonatal Med 2004, 16: Kumar M, Chandra S, Ijaz J, Senthilselvan A: Epidural analgesia in labour and neonatal respiratory distress: a case control study. Arch Dis Child Fetal Neonatal Ed 2014, 99(2):F Armani M, Gaggiano C, Dallaglio S, Romanini E, Sospiri C, Magnani C: Are there any strategies to improve neonatal outcomes associated with epidural analgesia in epidural analgesia in labor? Acta Biomed 2013, (84)2: Reynolds F, Sharma SK, Seed PT: Epidural analgesia and fetal acid base balance: a meta-analysis comparing epidural with systemic opioid alangesia. BJOG 2002, 109:
5 Shrestha et al. Italian Journal of Pediatrics (2014) 40:99 Page 5 of Ngyuen US, Rothman KJ, Demissie S, Jackson DJ, Lang JM, Ecker JL: Epidural analgesia and risks of Cesarean and operative vaginal deliveries in nulliparous and multiparous women. Matern Child Health J 2010, 14: Indraccolo U, Di Filippo D, Di Iorio R, Marinoni E, Roselli D, Indraccollo SR: Effect of epidural analgesia on operative vaginal birth rate. Clin Exp Obstet Gynecol 2011, 38(3): O Hana HP, Levy A, Rozen A, Greemberg L, Shapira Y, Sheiner E: The effect of epidural analgesia on labor progress and outcome in nulliparous women. J Matern Fetal Neonatal Med 2008, 21: Torvaldsen S, Roberts CL: No increased risk of caesarean or instrumental delivery for nulliparous women who have epidural analgesia early in (term) labour. Evid Based Med 2012, 17(1): Submit your next manuscript to BioMed Central and take full advantage of: Convenient online submission Thorough peer review No space constraints or color figure charges Immediate publication on acceptance Inclusion in PubMed, CAS, Scopus and Google Scholar Research which is freely available for redistribution Submit your manuscript at
Maternal & fetal outcomes after regional labour analgesia Ultra low dose epidurals to BUMPES. Dr Bernard J Norman November 2012
Maternal & fetal outcomes after regional labour analgesia Ultra low dose epidurals to BUMPES Dr Bernard J Norman November 2012 Mother Fetus Mother The Birth of Queen Victoria s Eighth Child, Prince Leopold,
More informationOB Div News March 2009
OB Div News March 2009 Several articles in this month s review have come from Canadian institutions. In spite of my pride in being Canadian, which was enhanced during the Olympics, this is purely coincidental.
More informationCOMPLICATIONS OF PRE-GESTATIONAL AND GESTATIONAL DIABETES IN SAUDI WOMEN: ANALYSIS FROM RIYADH MOTHER AND BABY COHORT STUDY (RAHMA)
COMPLICATIONS OF PRE-GESTATIONAL AND GESTATIONAL DIABETES IN SAUDI WOMEN: ANALYSIS FROM RIYADH MOTHER AND BABY COHORT STUDY (RAHMA) Prof. Hayfaa Wahabi, King Saud University, Riyadh Saudi Arabia Hayfaa
More informationTitle: Epidural Analgesia for Pain Management in Labour. Date: May 03, 2007
Title: Epidural Analgesia for Pain Management in Labour Date: May 03, 2007 Context and policy issues: Balancing pain control with unwanted maternal and neonatal effects remains a hotly debated topic for
More informationJOURNAL OF INTERNATIONAL ACADEMIC RESEARCH FOR MULTIDISCIPLINARY Impact Factor 3.114, ISSN: , Volume 5, Issue 3, April 2017
PREVALENCE OF POSTPARTUM DEPRESSION AMONG WOMEN-A CROSS SECTIONAL STUDY MRS.RAJESWARI.H* *Professor & HOD, Dept. of Mental Health Nursing, Narayana College of Nursing, Chinthareddypalem, Nellore, Andhrapradesh,
More informationClinicoetiological profile and risk assessment of newborn with respiratory distress in a tertiary care centre in South India
International Journal of Contemporary Pediatrics Sahoo MR et al. Int J Contemp Pediatr. 2015 Nov;2(4):433-439 http://www.ijpediatrics.com pissn 2349-3283 eissn 2349-3291 Research Article DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20150990
More informationClinical Study Labour Analgesia When Epidural Is Not a Choice: Tramadol versus Pentazocine
ISRN Obstetrics and Gynecology, Article ID 930349, 4 pages http://dx.doi.org/10.1155/2014/930349 Clinical Study Labour Analgesia When Epidural Is Not a Choice: versus Jyothi Shetty, Ashwini Vishalakshi,
More informationThe Effect of Meperidine on Peripartum Breastfeeding and Neonatal Weight
The Effect of Meperidine on Peripartum Breastfeeding and Neonatal Weight Fardin Yousefshahi; M.D. 1, Mahboobeh Asadi; M.D. 2, Fateme Rahimi; M.D. 3, Mohammad Javad Hoseinzade; M.D. 4, Fatemeh Davari Tanha;
More informationRemifentanil PCA In Labor
Remifentanil PCA In { Jennifer Lucero, MD Clinical Instructor UCSF Department of Anesthesia Remifentanil PCA in Discuss the Pharmokinectics of Remifentanil Review literature on the use of Remifentanil
More informationMaternal And Fetal Outcome In Pregnancies Complicated With Maternal Cardiac Diseases: Experience At A Tertiary Care Hospital
ISPUB.COM The Internet Journal of Gynecology and Obstetrics Volume 19 Number 1 Maternal And Fetal Outcome In Pregnancies Complicated With Maternal Cardiac Diseases: Experience At A Tertiary Care Hospital
More informationEffect of Various Degrees of Maternal Hyperglycemia on Fetal Outcome
ORIGINAL ARTICLE Effect of Various Degrees of Maternal Hyperglycemia on Fetal Outcome ABSTRACT Shagufta Tahir, Shaheen Zafar, Savita Thontia Objective Study design Place & Duration of study Methodology
More informationAnesthetics, Local a / or Anesthesia, Epidural a / or Anesthesia, Obstetrical a / or Pain, Postoperative a / or Postpartum Period a
Appendix 1. Literature Search Databases Years Search Terms Pubmed 01/1966 1. Analgesics, Opioid a / or Opioid-related Disorders a / PsycINFO EMBASE Cochrane 09/2016 or Heroin a / or Heroin Dependence a
More informationEpidural Analgesia: The Best Mix
Epidural Analgesia: The Best Mix Clinical Associate Professor Nolan McDonnell FANZCA MClinRes Department of Anaesthesia and Pain Medicine King Edward Memorial Hospital for Women Subiaco, Western Australia
More informationRichard Smiley, MD, PhD Virginia Apgar MD Professor of Anesthesiology Chief, Obstetric Anesthesia Columbia University Medical Center New York, NY,
Richard Smiley, MD, PhD Virginia Apgar MD Professor of Anesthesiology Chief, Obstetric Anesthesia Columbia University Medical Center New York, NY, USA Disclosures Off label use: Fentanyl, Sufentanil IT
More informationWhat s New in Post-Cesarean Analgesia?
Anesthesia & Obstetrics What s New in Post-Cesarean Analgesia? October 23rd, 2013 2013 UCSF What Does The Evidence Tell Us? Mark Rollins, MD, PhD UC SF Post-Delivery Pain (Mean pain scores for first 24
More informationA study of neonatal and maternal outcomes of asthma during pregnancy
International Journal of Research in Medical Sciences Meena BL et al. Int J Res Med Sci. 2013 Feb;1(1):23-27 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Research Article DOI: 10.5455/2320-6012.ijrms20130206
More informationA S Y N T H E S I Z E D H A N D B O O K ON G E S T A T I O N A L D I A B E T E S
A S Y N T H E S I Z E D H A N D B O O K ON G E S T A T I O N A L D I A B E T E S P R E F A C E Dear reader, This is a synthesized handbook conceived to serve as a tool to health personnel in the screening,
More informationLabour Epidurals and Maternal Pyrexia
Labour Epidurals and Maternal Pyrexia Katherine W. Arendt, MD Associate Professor of Anesthesiology Mayo Clinic, Rochester, Minnesota Obstetric Anaesthetists Association November 2, 2015 2013 MFMER slide-1
More informationVishwanath Pattan Endocrinology Wyoming Medical Center
Vishwanath Pattan Endocrinology Wyoming Medical Center Disclosure Holdings in Tandem Non for this Training Introduction In the United States, 5 to 6 percent of pregnancies almost 250,000 women are affected
More informationExperience of Back Pain Symptoms and the Choice of Epidural Analgesia in Labour: a Patient Questionnaire Survey
Experience of Back Pain Symptoms and the Choice of Epidural Analgesia in Labour: a Patient Questionnaire Survey MWN WONG MBBS, Dip Biomechanics, FRCS, FHKCOS, FHKAM (Orthopaedic Surgery) Department of
More informationAppendix 1: summary of the modified GRADE system (grades 1A 2D)
Appendix 1: summary of the modified GRADE system (grades 1A 2D) 1A 1B 1C 1D 2A 2B 2C 2D Strong recommendation High-quality evidence Benefits clearly outweigh risk and burdens, or vice versa Consistent
More informationROLE OF ANTIRETROVIRAL THERAPY IN HIV POSITIVE PREGNANT WOMEN
Page1 Research Article Biological Sciences ROLE OF ANTIRETROVIRAL THERAPY IN HIV POSITIVE PREGNANT WOMEN P.S.Rashmi 1, Hegde Kiran 2, Patil Rajashri 3, Vijayanath.V 4* 1 Department of Obstetrics & Gyeanecology,
More informationWang Linhong, Deputy Director, Professor National Center for Women and Children s Health, China CDC
Maternal and Child Health in China Wang Linhong, Deputy Director, Professor National Center for Women and Children s Health, China CDC Table of Contents 1 MCH Development and Situation in China 2 MCH Resources
More informationA descriptive study of the prevalence of hypothyroidism among antenatal women and foetal outcome in treated hypothyroid women
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Prasad DR et al. Int J Reprod Contracept Obstet Gynecol. 2016 Jun;5(6):1892-1896 www.ijrcog.org pissn 2320-1770 eissn 2320-1789
More informationEpidural analgesia and backache: a randomized controlled comparison with intramuscular meperidine for analgesia during labour
British Journal of Anaesthesia 89 (3): 466-72 (2002) analgesia and backache: a randomized controlled comparison with intramuscular meperidine for analgesia during labour B. A. Loughnan *, F. Carli 2, M.
More informationDATE: 17 January 2011 CONTEXT AND POLICY ISSUES
TITLE: Use of Fentanyl and Continuous Electronic Fetal Monitoring in Labour and Delivery: A Review of Clinical Effectiveness, Safety, and Clinical Practice Guidelines DATE: 17 January 2011 CONTEXT AND
More informationRelationship between incident types and impact on patients in drug name errors: a correlational study
Tsuji et al. Journal of Pharmaceutical Health Care and Sciences (2015) 1:11 DOI 10.1186/s40780-015-0011-x RESEARCH ARTICLE Open Access Relationship between incident types and impact on patients in drug
More informationPostpartum depression- A study from a tertiary care hospital
Original article Postpartum depression- A study from a tertiary care hospital 1Dr.Ramalingam Kolisetty, 2 Dr.Neeli Uma Jyothi 1Professor, Department of Obstetrics & Gynaecology, NRI Medical College 2Associate
More informationCase Discussions Cynthia A. Wong, M.D.
Case Discussions Cynthia A. Wong, M.D. Association des Anesthѐsiologistes du Quѐbec April 2014 CASE 1 Maternal Mortality Lewis G (ed). CEMACH 2007. Saving Mothers Lives 2003-2005 Pregnancy Complications
More informationDiagnosis of gestational diabetes mellitus: comparison between National Diabetes Data Group and Carpenter Coustan criteria
Asian Biomedicine Vol. 8 No. 4 August 2014; 505-509 Brief communication (Original) DOI: 10.5372/1905-7415.0804.320 Diagnosis of gestational diabetes mellitus: comparison between National Diabetes Data
More informationOptions for analgesia when a regional technique is not possible
Options for analgesia when a regional technique is not possible Damien Hughes Ulster Hospital Belfast Damien.Hughes@setrust.hscni.net History Progress. Plus ça change.. Basic choices.. Pharmacological
More informationThe Effect of Valvular Heart Diseases on Maternal and Fetal Outcome of Pregnancy Nada Salih Ameen*,Nawfal Fawzi Anwer**
THE VALVULAR IRAQI POSTGRADUATE HEART DISEASES MEDICAL AND JOURNAL PREGNANCY The Effect of Valvular Heart Diseases on Maternal and Fetal Outcome of Pregnancy Nada Salih Ameen*,Nawfal Fawzi Anwer** ABSTRACT:
More informationMaternal Outcome in Heart Disease in Pregnancy.
RESEARCH AND REVIEWS: JOURNAL OF MEDICAL AND HEALTH SCIENCES Maternal Outcome in Heart Disease in Pregnancy. Vijaya Balasaheb Chinchawade*, Rekha G Daver, and Preeti Lewis. Govt Medical College, Miraj,
More informationPostpartum LARC. (Long Acting Reversible Contraception) NURSING EDUCATION
Postpartum LARC (Long Acting Reversible Contraception) NURSING EDUCATION What is LARC Long-acting reversible contraception (LARC) methods include the intrauterine device (IUD) and the birth control implant.
More informationCord blood bilirubin used as an early predictor of hyperbilirubinemia
International Journal of Contemporary Pediatrics Ramamoorthy K et al. Int J Contemp Pediatr. 218 Jul;5(4):128-1285 http://www.ijpediatrics.com pissn 2349-3283 eissn 2349-3291 Original Research Article
More informationIntrapartum and Postpartum Management of the Diabetic Mother and Infant
Intrapartum and Postpartum Management of the Diabetic Mother and Infant Intrapartum Management Women with gestational diabetes who maintain normal glucose levels during pregnancy on diet and exercise therapy
More informationObjectives. Outline. Section 1: Interaction between HIV and pregnancy. Effects of HIV on Pregnancy. Section 2: Mother-to-Child-Transmission (MTCT)
Objectives Prevention of Mother-to-Child Transmission (PMTCT) Teen Club Community Partners Training Programme By the end of the session participants will be able to: 1. Identify factors affecting the transmission
More informationT. GIRARD ( 1 ), C. KERN ( 2 ), I. HÖSLI ( 3 ), A. Heck ( 4 ) and M. C. SCHNEIDER ( 1 )
(Acta Anaesth. Belg., 2006, 57, 45-49) Ropivacaine versus Bupivacaine 0.125% with Fentanyl 1µg/ml for Epidural Labour Analgesia : Is Daily Practice More Important Than Pharmaceutical Choice? T. GIRARD
More informationPOLICY and PROCEDURE
Misericordia Community Hospital Administration of Intravenous FentaNYL During Labour POLICY and PROCEDURE Labour and Delivery Manual Original Date Revised Date Approved by: Director, Women s Health, Covenant
More informationStudy of the role of low dose magnesium Sulphate in Hypertensive Disorders of Pregnancy 1 2
ORIGINAL ARTICLE J Pub Health Med Res 2015;3(2):31-37 Study of the role of low dose magnesium Sulphate in Hypertensive Disorders of Pregnancy 1 2 Shubha C.R. Vailaya, Naveena Kumari M. 1 Chief Consultant
More informationSURGICAL REMOVAL OF A LOOPED AND KNOTTED EPIDURAL CATHETER IN A POSTPARTUM PATIENT
SURGICAL REMOVAL OF A LOOPED AND KNOTTED EPIDURAL CATHETER IN A POSTPARTUM PATIENT - A Case Report - O. AL-KAYED *, F. AL-BOUTI **, AND M.O. ABABNEH *** Summary We report a case of unsuccessful removal
More informationManagement of Pregestational and Gestational Diabetes Mellitus
Background and Prevalence Management of Pregestational and Gestational Diabetes Mellitus Pregestational Diabetes - 8 million women in the US are affected, complicating 1% of all pregnancies. Type II is
More informationInfluence of Abnormal GCT with Normal or Impaired OGTT on Neonatal Outcome
JMSCR Volume 2 Issue 9 Page 2471-2482 September-2014 2014 www.jmscr.igmpublication.org Impact Factor 3.79 ISSN (e)-2347-176x Influence of Abnormal GCT with Normal or Impaired OGTT on Neonatal Outcome Authors
More informationMisconceptions about neuraxial analgesia
Anesthesiology Clin N Am 21 (2003) 59 70 Misconceptions about neuraxial analgesia Stephen H. Halpern, MD, MSc a,b, *, Barbara L. Leighton, MD c a Departments of Anesthesia and Obstetrics and Gynecology,
More informationPast Medical History
Past Medical History Statement of Goals Know how to obtain a thorough, age appropriate past medical history. Learning Objectives A. Describe a past medical history (PMH) as a record of the patient s past
More informationAssessment of knowledge and education relating to asthma during pregnancy among women of childbearing age
Al Ghobain et al. Asthma Research and Practice (2018) 4:2 DOI 10.1186/s40733-017-0038-x RESEARCH Open Access Assessment of knowledge and education relating to asthma during pregnancy among women of childbearing
More informationMorbidity profile of infants of mothers with gestational diabetes admitted to a tertiary care centre
International Journal of Contemporary Pediatrics Devi Meenakshi K. BB et al. Int J Contemp Pediatr. 2017 May;4(3):960-965 http://www.ijpediatrics.com pissn 2349-3283 eissn 2349-3291 Original Research Article
More informationThe Science and Practice of Perinatal Tobacco Use Cessation
1 The Science and Practice of Perinatal Tobacco Use Cessation Erin McClain, MA, MPH Catherine Rohweder, DrPH Cathy Melvin, PhD, MPH erin_mcclain@unc.edu Prevention of Tobacco Use and Secondhand Smoke Exposure
More informationCombined spinal-epidural analgesia represents the gold standard for regional analgesia in labour
Combined spinal-epidural analgesia represents the gold standard for regional analgesia in labour Felicity Plaat Queen Charlotte s Hospital, Imperial College NHS Trust London Combined spinal-epidural analgesia
More informationThe effects of epidural analgesia on labor, maternal, and neonatal outcomes: A systematic review
The effects of epidural analgesia on labor, maternal, and neonatal outcomes: A systematic review Barbara L. Leighton, MD, a and Stephen H. Halpern, MD b, c New York, NY, and Toronto, Ontario, Canada. Mothers
More informationCurrent Management of Labour Analgesia Epidural or CSE, Bolus or Infusions?
Current Management of Labour Analgesia Epidural or CSE, Bolus or Infusions? Dr Mark Esler Queen Charlotte s and Chelsea Hospital Imperial College Healthcare NHS Trust 2 nd October 2013 2 kangaroos and
More informationOriginal article Pravara Med Rev 2010; 2(3)
Original article Pravara Med Rev 2010; 2(3) A randomized clinical trial to compare continuous epidural infusion technique with that of intermittent boluses for maintenance of epidural labour analgesia
More informationRe-growth of an incomplete discoid lateral meniscus after arthroscopic partial resection in an 11 year-old boy: a case report
Bisicchia and Tudisco BMC Musculoskeletal Disorders 2013, 14:285 CASE REPORT Open Access Re-growth of an incomplete discoid lateral meniscus after arthroscopic partial resection in an 11 year-old boy:
More informationHuman immunodeficiency virus (HIV) can be HJOG. HIV infection in pregnancy: Analysis of twenty cases. Research. Abstract
HJOG An Obstetrics and Gynecology International Journal Research HIV infection in pregnancy: Analysis of twenty cases Kasioni Spiridoula 1, Pappas Stefanos 2, Vlachadis Nikolaos 3, Valsamidi Irene 1, Stournaras
More informationWhat s New in Postpartum Depression: A 2016 Review. Kathleen Kendall-Tackett, PhD, IBCLC, FAPA
What s New in Postpartum Depression: A 2016 Review Kathleen Kendall-Tackett, PhD, IBCLC, FAPA Nothing to Disclose PMADs (Postpartum Mood and Anxiety Disorders) Anxiety Perinatal Depression Depression PTSD
More informationThe validity of the diagnosis of inflammatory arthritis in a large population-based primary care database
Nielen et al. BMC Family Practice 2013, 14:79 RESEARCH ARTICLE Open Access The validity of the diagnosis of inflammatory arthritis in a large population-based primary care database Markus MJ Nielen 1*,
More informationOpioid Use Disorder- Pregnancy Principles and Myths. Brian Iriye MD and Farzad Kamyar MD High Risk Pregnancy Center
Opioid Use Disorder- Pregnancy Principles and Myths Brian Iriye MD and Farzad Kamyar MD High Risk Pregnancy Center History of NAS/NOWS Prior to 1875 infants not thought to be affected Congenital Morphinism
More informationEVALUATION OF THYROID FUNCTION IN PRE-ECLAMPSIA
EVALUATION OF THYROID FUNCTION IN PRE-ECLAMPSIA K. Sunanda 1, P. Sravanthi 2, H. Anupama 3 1Assistant Professor, Department of Obstetrics & Gynaecology, Gandhi Medical College/Hospital. 2Post Graduate,
More informationINTRODUCTION. Baltimore, Maryland 6 School of Medicine West Virginia University, Morgantown, West Virginia
The American Journal on Addictions, 27: 92 96, 2018 Copyright 2018 American Academy of Addiction Psychiatry ISSN: 1055-0496 print / 1521-0391 online DOI: 10.1111/ajad.12687 Brief Report: Treating Women
More informationChronic pain after childbirth. Petter Kainu Split
Chronic pain after childbirth Petter Kainu Split 9.5.13 Backround: 128 milj. births per year world wide 18.5 milj. caesarean sections (WHO 2008) 234 milj. surgical operations per year (WHO 2004) Chronic
More informationImpact of Delivery Types on Women s Postpartum Sexual Health
Reproduction & Contraception (2003) 14 (4):237~242 Impact of Delivery Types on Women s Postpartum Sexual Health Huan-ying WANG 1, Xiao-yang XU 2, Zhen-wei YAO 1, Qin ZHOU 1 Key words: postpartum; sexual
More informationViolence against Women by their Husband and Postpartum Depression
Original Article J Nepal Health Res Counc 2012 Sep;10(22):176-80 Violence against Women by their Husband and Postpartum Depression Budhathoki N, 1 Dahal M, 2 Bhusal S, 1 Ojha H, 1 Pandey S, 1 Basnet S
More informationLindsey Tingen, MD Department of Obstetrics and Gynecology, Greenville Health System Greenville, SC
Postpartum IUD Insertion: Continued Usage at Six Months Based on Expulsion and Removal Rates at Greenville Memorial Hospital in the First Year After Adoption of the Practice Lindsey Tingen, MD Department
More informationFetal Heart Rate Monitoring Myths and Misperceptions s: Electronic Fetal Heart Rate Monitoring (EFM): Baseline Assumptions.
Can FHR Monitoring Prevent Hypoxic-Ischemic Encephalopathy in the Newborn? Fetal Heart Rate Monitoring Myths and Misperceptions 1. Yes 2. No 72% Tekoa L. King CNM, MPH June 6, 2008 28% Yes No Objectives
More informationJMSCR Vol 05 Issue 04 Page April 2017
www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i4.99 Original Articles Umbilical Cord Bilirubin-an
More informationA CLINICAL STUDY OF GESTATIONAL DIABETES MELLITUS IN A TEACHING HOSPITAL IN KERALA Baiju Sam Jacob 1, Girija Devi K 2, V.
A CLINICAL STUDY OF GESTATIONAL DIABETES MELLITUS IN A TEACHING HOSPITAL IN KERALA Baiju Sam Jacob 1, Girija Devi K 2, V. Baby Paul 3 HOW TO CITE THIS ARTICLE: Baiju Sam Jacob, Girija Devi K, V. Baby Paul.
More informationPrevalence and risk factors of postpartum depression in mothers attending child immunization clinic of a Teaching Hospital in Kathmandu
51 Original Article Prevalence and risk factors of postpartum depression in mothers attending child immunization clinic of a Teaching Hospital in Kathmandu Khakurel G 1, Chalise P 2, Karki PK 1, Mahotra
More informationSwiss Association of Obstetric Anesthesia Swiss Association of Anesthesia & Resuscitation Satellite Meeting Interlaken, Switzerland 2007 Lawrence C.
CSE s for Labor Analgesia PRO! Swiss Association of Obstetric Anesthesia Swiss Association of Anesthesia & Resuscitation Satellite Meeting Interlaken, Switzerland 2007 Lawrence C. Tsen, MD Director of
More informationMidwifery 30 (2014) Contents lists available at ScienceDirect. Midwifery. journal homepage:
Midwifery 30 (2014) 36 42 Contents lists available at ScienceDirect Midwifery journal homepage: www.elsevier.com/midw Subcutaneous administration of fentanyl in childbirth: An observational study on the
More informationComparative Study between Acarbose and Insulin in the Treatment of GDM.
Original Article DOI: 10.21276/aimdr.2018.4.2.OG5 ISSN (O):2395-2822; ISSN (P):2395-2814 Comparative Study between Acarbose and Insulin in the Treatment of GDM. Minthami Sharon 1, Niloufur Syed Bashutheen
More informationOAA Survey 156: Current prescribing practices for post-operative analgesia following emergency and elective LSCS
OAA Survey 56: Current prescribing practices for post-operative analgesia following emergency and elective LSCS Janis M Ferns, Jennifer Lambert, Dharshini Radhakrishnan 2. Specialty Trainee, Barts and
More informationStudy of renal functions in neonatal asphyxia
Original article: Study of renal functions in neonatal asphyxia *Dr. D.Y.Shrikhande, **Dr. Vivek Singh, **Dr. Amit Garg *Professor and Head, **Senior Resident Department of Pediatrics, Pravara Institute
More informationPregnancy complications in women with rare tumor suppressor syndromes affecting central and peripheral nervous system
Pregnancy complications in women with rare tumor suppressor syndromes affecting central and peripheral nervous system The Harvard community has made this article openly available. Please share how this
More informationProgression from gestational diabetes to type 2 diabetes in one region of Scotland: an observational follow-up study
Eades et al. BMC Pregnancy and Childbirth (2015) 15:11 DOI 10.1186/s12884-015-0457-8 RESEARCH ARTICLE Open Access Progression from gestational diabetes to type 2 diabetes in one region of Scotland: an
More informationPost - caesarean section pyrexia and its relation of rupture of membranes and prophylactic antibiotics
MOJ Women s Health Research Article Open Access Post - caesarean section pyrexia and its relation of rupture of membranes and prophylactic antibiotics Abstract Objectives: To determine the incidence of
More informationKnowledge on legislation of abortion and experience of abortion among female youth in Nepal: A cross sectional study
Adhikari Reproductive Health (2016) 13:48 DOI 10.1186/s12978-016-0166-4 RESEARCH Open Access Knowledge on legislation of abortion and experience of abortion among female youth in Nepal: A cross sectional
More informationGestational Diabetes in Rural Antenatal Clinics:
Gestational Diabetes in Rural Antenatal Clinics: How do we compare? Cook SJ 1,2, Phelps L 1, Kwan M 2 Darling Downs Health and Hospital Service University of Queensland Rural Clinical School Gestational
More informationThe Cornell Peripartum Psychosis Management Tool
The Cornell Peripartum Psychosis Management Tool Benjamin Brody, MD Assistant Professor of Clinical Psychiatry Weill Cornell Medical College Chief, Division of Inpatient Psychiatry Weill Cornell Medical
More informationOpioid Use Disorders and Pregnancy. Marcela Smid, MD Maternal-Fetal Medicine
Opioid Use Disorders and Pregnancy Marcela Smid, MD Maternal-Fetal Medicine UNIVERSITY OF UTAH HEALTH, 2017 OBJECTIVES Definitions Epidemiology Pharmacology Effects on pregnancy Screening Treatment CARE
More informationDoes Oral Gabapentin Administered Prior to Scheduled Cesarean Delivery Decrease Pain With Movement in Adult Women at 24 Hours as Compared to Placebo?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 216 Does Oral Gabapentin Administered Prior
More informationSurveillance report Published: 8 June 2017 nice.org.uk. NICE All rights reserved.
Surveillance report 2017 Antenatal and postnatal mental health: clinical management and service guidance (2014) NICE guideline CG192 Surveillance report Published: 8 June 2017 nice.org.uk NICE 2017. All
More informationA new score predicting the survival of patients with spinal cord compression from myeloma
Douglas et al. BMC Cancer 2012, 12:425 RESEARCH ARTICLE Open Access A new score predicting the survival of patients with spinal cord compression from myeloma Sarah Douglas 1, Steven E Schild 2 and Dirk
More informationHbA1c level in last trimester pregnancy in predicting macrosomia and hypoglycemia in neonate
International Journal of Contemporary Pediatrics Subash S et al. Int J Contemp Pediatr. 2016 Nov;3(4):1334-1338 http://www.ijpediatrics.com pissn 2349-3283 eissn 2349-3291 Original Research Article DOI:
More informationOBSTETRICS Intrathecal morphine reduces breakthrough pain during labour epidural analgesia
British Journal of Anaesthesia 98 (2): 241 5 (2007) doi:10.1093/bja/ael346 Advance Access publication January 8, 2007 OBSTETRICS Intrathecal morphine reduces breakthrough pain during labour epidural analgesia
More informationCSE Analgesia Represents the Gold Standard for Regional Analgesia in Labour
CSE Analgesia Represents the Gold Standard for Regional Analgesia in Labour Dr Jason Reidy Nuffield Department of Anaesthetics Oxford University Hospitals CSE analgesia does not represent the gold standard
More informationPostpartum Depression in Women Admitted to a Kangaroo Mother Care Ward
Postpartum Depression in Women Admitted to a Kangaroo Mother Care Ward Elzet Venter Kalafong Hospital Department of Paediatrics University of Pretoria Introduction Postpartum depression (PPD) incidence
More informationPaediatrica Indonesiana. Echocardiographic patterns in asphyxiated neonates. Maswin Masyhur, Idham Amir, Sukman Tulus Putra, Alan Roland Tumbelaka
Paediatrica Indonesiana VOLUME 49 July NUMBER 4 Original Article Echocardiographic patterns in asphyxiated neonates Maswin Masyhur, Idham Amir, Sukman Tulus Putra, Alan Roland Tumbelaka Abstract Background
More informationDeterminant factors of pregnant mothers knowledge on mother to child transmission of HIV and its prevention in Gondar town, North West Ethiopia
Malaju and Alene BMC Pregnancy and Childbirth 2012, 12:73 RESEARCH ARTICLE Open Access Determinant factors of pregnant mothers knowledge on mother to child transmission of HIV and its prevention in Gondar
More informationCircumcision bleeding complications: Neonatal intensive care infants compared to. those in the normal newborn nursery
Circumcision bleeding complications: Neonatal intensive care infants compared to those in the normal newborn nursery Abigail R. Litwiller MD 1, David M. Haas MD, MS 2 1 Department of OB/GYN, University
More informationMitra et al. Sri Lankan Journal of Anaesthesiology: 23(2):61-65(2015) DOI: /slja.v23i2.8068
DOI: 10.4038/slja.v23i2.8068 Evaluation of analgesic efficacy of the combination of fentanyl with low dose bupivacaine vs ropivacaine using patient controlled epidural analgesia for control of labour pain-
More informationMaternal and perinatal outcome in antenatal women with hypothyroidism
Original Research Article Maternal and perinatal outcome in antenatal women with hypothyroidism Polumuru Usha Devi 1, Gundu Vanaja 1* 1 Assistant Professor of Obstetrics and Gynecology, Andhra Medical
More informationVol. 6, Issue, 8, pp , August, 2015 RESEARCH ARTICLE
ISSN: 0976-3031 Available Online at http://www.recentscientific.com International Journal of Recent Scientific Research Vol. 6, Issue, 8, pp.5699-5703, August, 2015 RESEARCH ARTICLE A DESCRIPTIVE STUDY
More informationResearch Article Challenges in Assessing Outcomes among Infants of Pregnant HIV-Positive Women Receiving ART in Uganda
Hindawi AIDS Research and Treatment Volume 2017, Article ID 3202737, 4 pages https://doi.org/10.1155/2017/3202737 Research Article Challenges in Assessing Outcomes among Infants of Pregnant HIV-Positive
More informationThe Nature and Management of Labor Pain: Part II. Pharmacologic Pain Relief
PRACTICAL THERAPEUTICS The Nature and Management of Labor Pain: Part II. Pharmacologic Pain Relief LAWRENCE LEEMAN, M.D., M.P.H., University of New Mexico School of Medicine, Albuquerque, New Mexico PATRICIA
More informationChanges in Air Force Fitness Measurements Pre- and Post-Childbirth
MILITARY MEDICINE, 177, 12:1519, 2012 Changes in Air Force Fitness Measurements Pre- and Post-Childbirth Lt Col Nicole H. Armitage, USAF NC*; Lt Col Denise A. Smart, WA ANG NC (Ret.) ABSTRACT U.S. Air
More informationShow Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital
Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital Overview Review overall (ERAS and non-eras) data for EA, PVB, TAP Examine
More informationClinical study of cardiac diseases during pregnancy
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Kamat AV et al. Int J Reprod Contracept Obstet Gynecol. 2016 Mar;5(3):855-859 www.ijrcog.org pissn 2320-1770 eissn 2320-1789
More informationThe Opioid-Exposed Woman
The Opioid-Exposed Woman Management Considerations for Labor and Delivery Jane Sublette, MS, RN, CNM, WHNP-BC Fairview Ridges Hospital Objectives Describe opioid-associated risks to the mother and fetus
More informationAlthough epidural bupivacaine is highly effective
Original Article 286 Comparison between 0.08% Ropivacaine and 0.06% Levobupivacaine for Epidural Analgesia during Nulliparous Labor: A Retrospective Study in A Single Center Hui-Ling Lee, MD; Liang-Ming
More informationFetal & Maternal Outcome of Diabetes Mellitus at Aljomhoria Hospital, Benghazi-Libya, 2010
Fetal & Maternal Outcome of Diabetes Mellitus at Aljomhoria Hospital, Benghazi-Libya, 2010 Najat Bettamer 1, Asma Salem Elakili 2, Farag Ben Ali 1 & Azza SH Greiw 3 1 Gynecology Department, 3 Family &
More information